Some causes of lower back or buttock pain are less common than others, but that certainly doesn’t make them any less painful. A neuromuscular condition known as piriformis syndrome can be very similar to sciatica in its presentation and level of pain, but there are definite differences between the two. Read on to learn more about what piriformis syndrome is, its signs and symptoms, who may be at risk, and what the prognosis is for this disorder.
What Is Piriformis Syndrome?
In the buttocks is a muscle known as the piriformis. Other than high school or college biology class, you may not have heard of it, but it’s a very significant muscle when it comes to how we move and walk. In fact, this muscle enables us to walk, while it keeps the hip joint stable and in place and allows the thigh to move freely. Nearly any motion we make with our lower body uses the piriformis muscle. However, sometimes this nerve can compress and put undue pressure on the sciatic nerve. The sciatic nerve is the longest nerve in the body, and it extends from the lower back to the toes, although it divides into two sections below the knee. When the sciatic nerve is irritated, pain and other symptoms occur. Piriformis syndrome can often be confused with sciatica, but some signs and symptoms set the two conditions apart.
Piriformis Syndrome Signs and Symptoms
The first symptom of piriformis syndrome is pain. The pain is most commonly felt in the lower back or the buttocks, but it can also be a radiating type of pain that travels down the back of the leg to the foot. Pain may be intermittent and may come and go. Patients may also experience excruciating pain while attempting certain movements, such as climbing stairs or jogging. Tingling and numbness are also common signs. Pain is usually similar regarding both sides of the body, whereas sciatica typically affects one side more than the other. Sciatica is often caused by lumbar radiculopathy, which is due to a herniated disk, while piriformis syndrome is a neuromuscular condition.
Piriformis Syndrome Diagnosis
Obtaining a diagnosis for piriformis syndrome can be difficult because of the nature of the condition. Often, your healthcare professional will provide you with a clinical interview, where he or she will ask you specific questions about your pain. Next, your physician may ask you to perform certain maneuvers to see which ones may cause you pain. Doctors experienced in spinal problems may be able to diagnose piriformis syndrome just on a physical exam alone; however, they may want to order other tests to rule out other potential problems. Your healthcare provider may order a CT scan, MRI, or ultrasound, to rule out a herniated disk (which is the root cause of sciatica). Some doctors may employ the use of magnetic resonance neurography, which can provide images of the sciatic nerve. In other cases, electrophysiologic nerve studies may be performed to provide a definitive diagnosis.
What Are the Causes and Risk Factors for Piriformis Syndrome?
Commonly, the cause of piriformis syndrome is directly related to the location of the piriformis muscle and the sciatic nerve itself. The nerve can arise from five different locations and exits through the buttocks, so on each patient, the relation of the piriformis muscle and sciatic nerve will be different. As the sciatic nerve is the largest in the body and the piriformis muscle expands the whole of the buttocks, any type of compression anywhere along the nerve tract can cause piriformis syndrome. However, certain risk factors put some more at risk than others.
Athletes, especially those who repeat the same motions over and over, such as lunging or running, are at higher risk of compressing the sciatic nerve. In this case, the best way to prevent piriformis syndrome later in life is to simply always practice proper form. Warming up and cooling down is also essential. Trauma to the leg or buttocks is also a risk factor for developing the syndrome.
Females are more likely to be affected by the disorder than men by a 6:1 ratio. This isn’t completely explained by science but is thought to be because of anatomical differences.
Prolonged sitting is also thought to be a cause of piriformis syndrome. Those who live sedentary lifestyles, or hold occupations that require them to sit a majority of the time, maybe putting undue pressure on the nerve.
What Are Treatments and Medications for Piriformis Syndrome?
There is no set standard or first-line treatment for piriformis syndrome. Some patients find success with home remedies such as ice packs or heat or avoiding strenuous and repetitive activity. It’s also a good idea to avoid prolonged sitting, especially if it is in an uncomfortable seat, or against something hard, such as a wallet in a back pocket.
Beyond the obvious home remedies, many doctors will opt for non-steroidal anti-inflammatory drugs, better known as NSAIDs. These include pain relievers such as aspirin, ibuprofen, or naproxen. Muscle relaxants are also commonly prescribed for nerve pain. Injections directly to the muscle are often considered if other treatments fail to work. Physical therapy or myofascial release techniques are also recommended as a regular course of treatment. If all conventional therapies fail, and the patient is still experiencing severe pain, surgery is an option. The surgery will essentially adjust the piriformis muscle to take the pressure off the sciatic nerve. However, this is always performed as a last resort.
What Is the Prognosis for Piriformis Syndrome?
The prognosis for piriformis syndrome varies for every patient. Unfortunately, the condition is often misdiagnosed and isn’t recognized as early as it should be by a healthcare provider. That is why you should seek the care of a specialist at NS2 if you are experiencing recurring pain. Piriformis syndrome can worsen over time and become chronic, which makes it harder to treat. If it is caught in the early stages of the condition, then more conventional therapies are likely to help, such as home remedies, physical therapies, and NSAIDs. However, it’s important to remember that the outlook is different for every patient. If you need more information about piriformis syndrome or would like to be evaluated by a physician, request an appointment with the physicians at NewSouth NeuroSpine. We have over 100 highly trained medical professionals on staff with expertise in orthopedic spine surgery, spinal intervention, physical medicine and rehabilitation, and neurosurgery fields.